High-level Communication Research Articles

Abstract PO-016: A latent class analysis of communication patterns between Hispanic and non-Hispanic childhood cancer survivors, parents, and medical providers

Abstract Introduction: The triad of communication between childhood cancer survivors (CCS), their parents, and their medical providers may motivate CCS healthcare engagement but has not been examined. This may be particularly important for Hispanic/Latino populations, who are more likely to trust and receive health information from hospital providers and are less likely to remain engaged in survivorship care compared to non-Hispanic white persons. Methods: We analyzed data from the Project Forward pilot study, a population-based study that evaluated follow-up care among 160 CCS-parent dyads (CCS mean age=20 years, 7 years from diagnosis, and 29% of parents identified as Spanish-speaking Hispanic). Nine indicators representing multiple dimensions of communication were used in latent class analysis to identify distinct classes of communication. These indicators were selected from the parent and CCS survey and asked about communication between CCS, parents, and medical providers. The association between resulting classes and various covariates (e.g., parent ethnicity/language, CCS demographic, clinical characteristics) was examined using multinomial logistic regression. Results: Three classes of the triad of communication were identified: (1) high healthcare-focused communication (37.5%); (2) high comprehensive communication (15.6%); and (3) overall low communication (46.9%). The high healthcare-focused communication class was characterized by patterns of high probability for communication about future health care needs among CCS, parents, and medical providers. The high comprehensive communication class was characterized by a high probability of communication about future healthcare needs and a high probability for parent-CCS communication about different cancer facets. The overall low communication class was characterized by a low probability of endorsing any communication items. Greater time since diagnosis was marginally significantly associated with reduced odds of the dyad's membership in class 2 [OR=0.798, 95% CI=0.635, 1.002, p-value=0.0520], compared to class 3 (low communication). Additionally, dyads with English-speaking non-Hispanic parents were less likely to be in class 2 [OR=0.361, 95% CI=0.130, 1.005, p-value=0.0511], compared to class 3. After adjusting for all covariates simultaneously, greater time since diagnosis was associated with reduced odds of membership in class 2 (vs class 3). Dyads with Spanish-speaking Hispanic parents were more likely to be in classes 1 and 2 (vs. class 3). Discussion: Our results support the need to enhance communication among CCS, parents, and medical providers generally to improve knowledge and understanding about the long-term effects of cancer, treatment, and outcomes. Our study suggests that dyads, where parents were Spanish-speaking Hispanics tended to engage in high communication. Examining language preference provides an important contextual understanding as it supports the notion that Hispanic/Latino cultural values may play a favorable role in high levels of communication. Citation Format: Carol Y. Ochoa, Junhan Cho, Kimberly A. Miller, Lourdes Baezconde-Garbanati, Randall Y. Chan, Albert J. Farias, Joel E. Milam. A latent class analysis of communication patterns between Hispanic and non-Hispanic childhood cancer survivors, parents, and medical providers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-016.

Differentiation of Personnel Motivation in the Context of Generational Theory

Since each generation has a value to offer organizations, the emergence of new ones is thoroughly scrutinized in order to have better understanding who to be dealing with as younger employees, representatives of new generation, exit university and enter the workforce. Building a team from different generations can be a distinctive valuable human resource sand benefit from over six decades of perspectives, experience and insights. However, in order to use this potential in a proper manner managers need to know some features that distinguish members of different generations. Members of each generation possess a particular set of values, attitudes and behaviors to the workplace. It is worth noting that the multigenerational workforce requires flexible leadership, policies and approaches of motivation. The main task in our days is the selection and motivation of personnel, determining the main directions of its improvement, which allows managers to attract, manage personnel, as well as achieve the goals of the organization and a positive economic result. Meanwhile, generational gap often causes conflicts between employees. Managers should be aware of and take into account the differences between generations when performing their functions. Hence, recommendations for the transformation of HR processes need to be systematized, taking into account the values, interests and needs of three generations that currently prevail in the Ukrainian labor market and a completely new generation of Alpha, which is just beginning to form. Motivated employees whose personal goals coincide with the goals of the enterprise supposed to work more effectively, which will lead to increasing of the profitability of the enterprise. As a result of the analysis of the main values and characteristics of four generations, recommendations for improving the socio-economic efficiency of personnel activities were formulated with the allocation of groups of employees according to the criterion of belonging to a certain generation, their features and main approaches to personnel management and motivation were highlighted. The theory of generations allows us to form an effective strategy for managing the human capital of an organization, which will take into account the mindset and behavior of representatives of different age groups. The high demand for talent forces modern companies to actively fight for human capital. To win it, it is necessary to offer the best conditions for representatives of each generation. Effective use of the aspects of generational theory allows managers to ensure a high level of communication between employees and more effectively predict their behavior. Keywords theory of generations; HR; Generation X; generation Y; generation Z; Alpha generation; values; motivation; management methods; management.

Visible Light Communication: a Brief Review

A brief review is devoted to an evolving technology of visible light communication. The information volume transferred between users is increasing and visible light communication is becoming the option for organizing information transfer channel due to the license free broadcasting frequency range, high communication channel capacity, high noise-immunity, and high-level communication channel security. The paper presents various data transfer systems based on white phosphor LEDs and RGB LEDs by various modulation and signal processing schemes to increase the data rate.

The Polyphony of the Silent: The Specifics of Dostoevsky’s Philosophical Discourse

The article describes the phenomenon of silence in Dostoevskys later prose. Philosophical, plot-forming and psychological aspects of silence are looked at. A confessional type of monologue is defined as a discursive genre, with specific roles of the speaker and his silent listeners, whose predominance in Dostoevskys prose lets the author of the article adjust the notion of polyphony and dialogue within the context of Dostoevskys poetics. The conventionality of the other in the confessional type of monologue is proved by the absence of the completing functions in listeners. In most cases Dostoevskys later works retain some rudimental forms of frantic dialogue while the role of specific monologue discourse, caused and conditioned by silence, is increasing. By semantics and function types of silence in Dostoevsky fall into three groups: 1) the underground silence as expression of human disunity in the epoch of universal solitude; 2) role silence of listeners in the discursive genre of confessional monologue; 3) sacred silence of Christ indicating transition to a new higher level of communication

120. Antimicrobial Prescribing Guidance and Communication Among Health Care Professionals in Five Guatemalan Hospitals

BackgroundCommunication among health care professionals during antimicrobial prescribing is critical to ensure appropriate use. This is of concern in Guatemala where physicians seldom consider guidance from other professionals during antimicrobial prescribing activities. MethodsWe carried out a cross sectional questionnaire and open ended interviews with physicians from five hospitals in Guatemala to describe perceptions of communication between health care providers, and acceptance of antimicrobial guidance during prescribing. ResultsFrom January to April 2021 an electronic questionnaire was sent to enrolled physicians of which 74% completed participation (n=107/145). Fifty-five percent participated in open ended interviews (n=79/145). Respondents perceived high levels of communication between physicians and ID specialists (94% of respondents); 52%, and 54% perceived high levels of physician-pharmacist, and physician-nurse communication respectively. Significant differences in the perception of physician-pharmacist communication were detected when comparing responses between hospitals, and between respondent sex (chi2, p< 0.05). Barriers to communication between professionals included lack of local guidelines or protocols, patient overload, COVID-19 pandemic, lack of mentorship, and little room to discuss antimicrobial therapy with higher-ranking physicians. Eighty percent and 45% of physicians were open to receiving antibiotic optimization recommendations from other physicians, and pharmacists respectively. Notable barriers to accepting recommendations from pharmacists included lack of regular communication, lack of clinical experience, and concern about evidence based recommendations. ConclusionEffective communication is perceived between physicians during antimicrobial prescribing activities. Marginal levels of communication and acceptance of prescribing recommendations have been detected between physicians and pharmacists.In this milieu, there is an opportunity to strengthen multidisciplinary teams to optimize antimicrobial use.Disclosures Mario Augusto Melgar Toledo, MD, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

Навички ефективної комунікації у сфері бухгалтерського обліку

The current stage of training future accountants is characterized by the development of their desire to be socially active and responsible, high level of communication, critical thinking and breadth of professional outlook, because the communication skills of accounting professionals are part of intellectual and educational components of their training. accountants need to master the relevant knowledge base and then turn the acquired knowledge into skills and abilities.

Timely Communication Through Telehealth: Added Value for a Caregiver During COVID-19.

Objective: This caregiver case study applies the lens of relational coordination theory (RC) to examine the value of telehealth as a medium of care coordination for a pediatric patient with hypermobile Ehlers-Danlos Syndrome (hEDS) during the COVID-19 pandemic.Background: The COVID-19 pandemic has placed an unprecedented burden on the delivery of healthcare around the globe and has increased the reliance on telehealth services. Delivering telehealth requires a high level of communication and coordination within and across providers as well as between providers, patients and their families. However, it is less clear how telehealth impacts the coordination of care. In this paper, we provide insight into the quality of care coordination between providers and an informal caregiver following policy changes to the provider payment structure in Massachusetts.Methods: This paper employs a single-case, autoethnographic study design where one of the authors uses their experiential insights, as mother of the patient, to inform a wider cultural and political understanding of the shift to remote caregiving for a pediatric patient with hEDS. Data was collected using reflective journaling, interactive interviews, and participant observation and analyzed using content analysis.Results: Findings revealed four interrelating roles of the caregiver including, logistics support, boundary spanner, home health aide, and cultural translator. The adoption of telehealth was associated with improved timeliness and frequency of communication between the caregiver and providers. Findings about the impact of telehealth adoption on accuracy of communication were mixed. Mutual respect between the caregiver and providers remained unchanged during the study period.Conclusions: This paper highlights areas where payer policy may be modified to incentivize timely communication and improve coordination of care through telehealth services. Additional insight from the perspective of an informal caregiver of a patient with a rare chronic disease provides an understudied vantage to the care coordination process. We contribute to relational coordination theory by observing the ways that caregivers function as boundary spanners, and how this process was facilitated by the adoption of telehealth. Insights from this research will inform the development of telehealth workflows to engage caregivers in a way that adds value and strengthens relational coordination in the management of chronic disease.

Linking empowerment, engagement, communication and organizational health: moderated mediation model

PurposeThis paper aims to examine the factors that mediate and moderate the relationship between psychological empowerment and organizational health. Specifically, work engagement is posited to mediate the relationship between psychological empowerment and organizational health and organizational communication to moderate the relationship between psychological empowerment and work engagement.Design/methodology/approachData were collected from 524 scientists belonging to 10 laboratories of CSIR – an Indian R&D organization. For statistical analysis of moderated-mediation model, hierarchical multiple regression and process macro for SPSS was used.FindingsResults revealed that work engagement was found to mediate the positive relationship between psychological empowerment and organizational health and organizational communication moderated the influence of psychological empowerment on work engagement. Results of moderated-mediation revealed that mediation of work engagement was moderated by organizational communication such that at higher levels of communication, the mediating effect of work engagement became stronger.Originality/valueThis study extends the understanding of the organizational health concept by studying the mediating effect of work engagement being moderated by organizational communication and its subsequent impact on organizational health.

Toward an Adaptive Threshold on Cooperative Bandwidth Management Based on Hierarchical Reinforcement Learning.

With the increase in Internet of Things (IoT) devices and network communications, but with less bandwidth growth, the resulting constraints must be overcome. Due to the network complexity and uncertainty of emergency distribution parameters in smart environments, using predetermined rules seems illogical. Reinforcement learning (RL), as a powerful machine learning approach, can handle such smart environments without a trainer or supervisor. Recently, we worked on bandwidth management in a smart environment with several fog fragments using limited shared bandwidth, where IoT devices may experience uncertain emergencies in terms of the time and sequence needed for more bandwidth for further higher-level communication. We introduced fog fragment cooperation using an RL approach under a predefined fixed threshold constraint. In this study, we promote this approach by removing the fixed level of restriction of the threshold through hierarchical reinforcement learning (HRL) and completing the cooperation qualification. At the first learning hierarchy level of the proposed approach, the best threshold level is learned over time, and the final results are used by the second learning hierarchy level, where the fog node learns the best device for helping an emergency device by temporarily lending the bandwidth. Although equipping the method to the adaptive threshold and restricting fog fragment cooperation make the learning procedure more difficult, the HRL approach increases the method’s efficiency in terms of time and performance.

Language changes in Alzheimer’s disease: A systematic review of verb processing

Alzheimer’s disease (AD) results in language impairments and higher-level communication problems. Research into the language of people with AD (pwAD) has mainly focused on nouns; however, improved understanding of verb processing by pwAD could improve diagnostic assessments and communicative interventions. This systematic review synthesizes findings of AD’s effects on verbs from single-word, sentence, and discourse tasks. Review of 57 studies revealed that pwAD were less accurate than controls on single-word tasks and less accurate with verbs than nouns on these tasks. They had difficulty comprehending sentences featuring multiple verbs or verbs with reversible thematic roles. Discourse production by pwAD was marked by vagueness, including declines in total output and propositional content and a preference for generic verbs and simple syntax. Few studies examining sentence production or discourse comprehension were found. Future research should address relationships between long-term memory and language preservation as well as verb use in discourse.

Analysis of students' mathematical communication ability in solving mathematical problems

The aim in study was to analyze the characteristics and levels of mathematical communication of students in solving mathematical problems. This study used a qualitative descriptive study with 6 of prospective teacher, 3 students from STIKIP Bangkalan and 3 prospective teacher students from STIKIP Al Hikmah Surabaya, Indonesia. Research data collection techniques through documentation of teaching preparation assignments, and video recordings during learning to obtain verbal mathematical communication. The comparison method is still used to analyze the data through the stages of data condensation, data display, conclusion drawing, and verification. The results show that the characteristics of mathematical communication consist of accurate, complete, smooth, and systematic. Each subject has different characteristics. The prospective teacher students with high-level communication can explain accurately, completely, fluently, and systematically facts, concepts, procedures, operations, and principles. For prospective teacher students with intermediate levels of mathematical communication can explain accurately, fluently, and systematically facts, concepts, procedures, operations, and mathematical principles. Whereas for low-level prospective teacher students, they can explain mathematics accurately.

РЕТРОСПЕКТИВНИЙ ПОГЛЯД НА ПРОБЛЕМУ СТАНОВЛЕННЯ ТЬЮТОРСЬКОГО СУПРОВОДУ МОРАЛЬНОГО ВИХОВАННЯ СТУДЕНТІВ ЯК НА ОСОБЛИВУ ФОРМУ НАСТАВНИЦТВА

In modern science, it is important to consider the mentoring system as the most effective way to use the human resources of the organization to solve strategic problems. The article considers the historical aspect of the emergence of mentoring as a method of transfer of experience, which was used for the moral education of children and youth. It is emphasized that mentoring is a centuries-old tradition, characteristic of all countries and as a social phenomenon inherent in all periods of human development. Its content is the transfer of a number of moral, intellectual, sometimes physical and material qualities. Mentor is a person who has some experience and knowledge, a high level of communication; seeks to help his students gain the experience necessary for self-improvement. The professionalism and experience of the mentors are joined by personal qualities: the ability to speak, listen, and interact. The work traces the formation of tutoring as a special form of mentoring, describes the prerequisites for its emergence and the degree of its relevance in our time. Born together with the first European universities, the modern institute of tutoring preserved and multiplied the norms, traditions and rules of mentoring of medieval universities; the author argues that tutoring and moral mentoring have the same roots. That is, tutoring appeared in classical English universities based on mentoring. The author emphasizes the need to modernize the modern education system of Ukraine in order to solve the problems of spiritual and moral development of the individual. The introduction of new strategies, in particular, tutoring, should be the key to solving the problems of the modern education system.&nbsp;&nbsp

Anomaly Detection in Non-Stationary Water Distribution Grids Using Fog Computing Architecture

The importance of process analysis in engineering, procurement and construction companies (EPC), due to the complexity of the measures, the high level of communication between people, different and non-integrated information systems, as well as the amount of capital involved in these projects is much higher and more challenging. Limited research has been done on exploring business processes in these companies. In this study, in order to better and more accurately analyze the company's performance, three perspectives of process mining (process flow, case and organizational) is analyzed by using the event logs recorded in the supplier selection process. The results of this study led to the identification of challenges in the process, including repetitive loops, duplicate activities, survey of factors affecting the implementation of the process and also examining the relationships between people involved in the project, which can be used to improve the future performance of the company.

Features and perceptions of a critical care outreach physician role

Objective: To describe the tasks completed by the critical care outreach physician (CCOP) and staff perceptions of the CCOP role.Design: Prospective observational study and survey of intensive care unit (ICU) staff.Setting: University-affiliated teaching hospital in Australia.Participants: ICU consultants, registrars and nurses.Interventions: Implementing a dedicated ICU consultant to review deteriorating patients outside the ICU.Main outcome measures: Prospective collection of CCOP tasks and survey of ICU staff.Results: During 101 clinical shifts, the CCOP had 1524 encounters (mean, 15.1 [standard deviation, 6.1]; median, 14 [interquartile range, 10–19] per day). The three commonest interventions were emergency department visits, direct consultant communication, and coordinating ICU admissions. Involvement in Medical Emergency Team (MET) calls, expediting patient care, and goals of care discussions were also relatively common. Survey responses were obtained from 55/84 (66%) eligible participants. Most respondents thought the CCOP would improve the predefined processes of care and patient-centred outcomes. The areas of greatest perceived benefit included supporting the MET registrar and coordinating simultaneous emergencies outside the ICU. Areas where the role was perceived to be less beneficial included improving handover, identifying patients at clinical risk outside the ICU, and reducing repeat MET calls.Conclusions: The tasks of a CCOP involved high level communication, coordination of care, and supervision of ICU staff. The effect of this role on patient-centred outcomes requires further research.

Fault detection in power grids based on improved supervised machine learning binary classification

Abstract With the increased complexity of power systems and the high integration of smart meters, advanced sensors, and high-level communication infrastructures within the modern power grids, the collected data becomes enormous and requires fast computation and outstanding analyzing methods under normal conditions. However, under abnormal conditions such as faults, the challenges dramatically increase. Such faults require timely and accurate fault detection, identification, and location approaches for guaranteeing their desired performance. This paper proposes two machine learning approaches based on the binary classification to improve the process of fault detection in smart grids. Besides, it presents four machine learning models trained and tested on real and modern fault detection data set designed by the Technical University of Ostrava. Many evaluation measures are applied to test and compare these approaches and models. Moreover, receiver operating characteristic curves are utilized to prove the applicability and validity of the proposed approaches. Finally, the proposed models are compared to previous studies to confirm their superiority.

Development of LKPD Teaching Materials Based on Community Science Technology To Improve Students’ High Level of Communication and Thinking Ability

This development research aims to realize the development of STM-based LKPD, to find out the effect of developing STM-based LKPD which is theoretically feasible and suitable for use by educators in classroom learning. The research method used is development research (Research and Development) by using research steps according to Borg and Gall. The population in this study were fifth grade elementary school/MI educators in Rajabasa District, Bandar Lampung City, which amounted to eight educators. The sample used in this study was a saturated sample, namely eight educators. This study uses a qualitative descriptive analysis. Data collection techniques in this study were carried out in two ways, namely observation, and questionnaires (needs analysis questionnaire). The instruments in this study consisted of: 1) needs analysis instruments, 2) materials expert validation instruments, media experts and linguists, 3) user validation instruments (educators). The results of prototype product development were validated by material experts, media experts and linguists and validated by users, namely fifth grade educators at SD/MI Rajabasa District, Bandar Lampung City, totaling eight educators to support students' communication and high-level thinking skills in the learning process in the classroom.

Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design.

BackgroundWe assessed the associations between patient‐clinician relationships (communication and involvement in shared decision‐making [SDM]) and adherence to antihypertensive medications.Methods and ResultsThe 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient‐clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self‐reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey‐weighted multivariable‐adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient‐clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty‐five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient‐clinician communication (OR, 1.38; 95% CI, 1.14–1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08–1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications.ConclusionsPatient‐clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.

Online Learning Satisfaction in Higher Education Amidst the Covid-19 Pandemic

Regarding the COVID 19 pandemic, the process should be analyzed very well in order to realize effective online education practices possessing high level communication and interaction in higher education. In this respect in this study, initially it is aimed to determine the satisfaction levels of higher education students towards online education during the pandemic process that affects the whole world and then to reveal the changes of these levels according to the variables such as gender, discipline, education level and grade level. A quantitative cross-sectional design was used in the study. The sample of the study consists of 13447 university students studying online in different faculties of Istanbul University-Cerrahpasa in the fall semester of 2020-2021. According to the results, the students' satisfaction with online education was at a moderate level. In addition, it was observed that students preferred Zoom from the synchronous platforms the most and Canvas from the asynchronous platforms in the online education process. On the other hand, satisfaction levels of female students differ significantly from male students, Science and Engineering and Social Sciences students were more satisfied with the process than the Medicine and Health Sciences students. 6th grade students' satisfaction with the process was higher than other grade levels, and graduate students' satisfaction differed significantly from undergraduate and associate degree students. Finally, the significant differences for all variables were at a low effect level. In the research, various suggestions were made for educators and future studies in order to create more effective online learning environments.

Continuous Subcutaneous Apomorphine Infusion in Parkinson's Disease: A Single-Center, Long-Term Follow-Up Study of the Causes for Discontinuation.

(1) Background: Subcutaneous apomorphine infusion (SCAI) is one of the three main treatment options for motor fluctuations in advanced Parkinson’s disease (PD). The adherence to SCAI is generally considered to be low due to adverse events and because it is perceived as a treatment option to be used for a limited period only. We evaluated the reasons for discontinuation of SCAI in relation to when patients stopped treatment. (2) Methods: We reviewed the medical records of PD patients treated with SCAI at a single center, capturing patient demographics and the reasons for cessation of SCAI. (3) Results: 101 patients were included in the analysis, with a median time on treatment of 6.34 years. The main reasons for stopping SCAI were adverse events, death, and dissatisfaction with treatment. In the first 6 years of treatment, the predominant side effects leading to discontinuation were somnolence and hallucinations. (4) Conclusions: We suggest that SCAI can be an effective long-term treatment option for advanced PD, but it requires careful patient selection, a high level of communication with the patient and carer, and rigorous monitoring of the effects of treatment and for any adverse events so they can be promptly managed.

Rethinking organizational change in the COVID-19 era

: Planned organizational change has a long history in formal organizations of all types. A model of planned organizational change from the existing literature can be used to identify a set of principles which can be offered for use during the current COVID-19 crisis, but this traditional model may not be fully adequate during this especially challenging period. A relatively new model from the field of complexity theory for organizations, Complex Adaptive Systems (CAS), offers promise for addressing the unique crisis conditions facing hospitals in the COVID-19 era. These conditions require constant assessment; ongoing high levels of communication; and iterative cycles of experimentation, reflection and learning, which can be better addressed in a CAS framework. Healthcare providers are experiencing periods of relative calm and interspersed crisis, which need to be proactively recognized and managed through sustained, “big picture” changes using timely combinations of traditional methods, complexity approaches, with the flexibility and ethical considerations of crisis management strategies built in. Successful crisis management requires leadership skills of those involved in decision-making at the local level, with a preference for the use of inclusive and adaptive leadership styles. Innovative strategies, teamwork, and crisis management models that have recently emerged may enable deeper systemic change in the long term. Any hospital or program in a healthcare system should be able to use this material to address a significant organizational change need.